Outcome Analysis of Chemoradiation in Unresectable Pancreatic Cancer Focusing on Treatment Sequencing Strategy

Aim: To analyze the outcomes of patients with unresectable pancreatic cancer after chemoradiotherapy (CCRT), focusing on sequencing strategy. Patients and Methods: Data of 144 patients treated from January 1989 to December 2013 were retrospectively analyzed. Patients were divided into the scheduled group (N=27), salvage group (N=37) and upfront group (N=80) per CCRT and chemotherapy sequence. Results: With a median follow-up of 10.4 months (range=1.4-164.2), median overall survival (OS) was 13.5 months. Patients in the upfront group had inferior performance status and received a lower radiation dose (p=0.007 and p<0.001, respectively). Higher radiation dose (=45 Gy) was the sole prognosticator related with improved survival in multivariate (p=0.001) analysis, whereas treatment sequence was not a significant prognostic factor (p=0.409). Conclusion: No difference was found among tested sequencing strategies that were all well-tolerated, despite skewed distribution for performance and radiation dose. An upfront approach may be a viable option for patients with limited performance to undergo more active systemic chemotherapy.